Short- and long-term impact of adapted physical activity and diet counseling during adjuvant breast cancer therapy: the "APAD1" randomized controlled trial.

BACKGROUND: Patients with breast cancer undergoing chemotherapy and radiotherapy experience fatigue and other treatment side effects. Integrative therapies combining physical activity and dietary counseling are recommended; however to date no large randomized controlled trial has been conducted during adjuvant therapy. The Adapted Physical Activity and Diet (APAD) intervention was evaluated for its ability to decrease fatigue (primary outcome), anxiety, depression, body mass index (BMI), and fat mass, and enhance muscular and cognitive performances, and quality-of-life (QoL). METHODS: Women diagnosed with early breast cancer (N = 143, mean age = 52 ± 10 years) were randomized to APAD or usual care (UC). APAD included thrice-weekly moderate-intensity mixed aerobic and resistance exercise sessions and 9 dietetic consultations. Patient-reported outcomes (PROs) and anthropometric, muscular, and cognitive variables were measured at baseline, 18 weeks (end of chemotherapy), and 26 weeks (end of radiotherapy and intervention), and at 6- and 12-month post-intervention follow-ups. Multi-adjusted linear mixed-effects models were used to compare groups over time. RESULTS: Significant beneficial effects of the APAD intervention were observed on all PROs (i.e., fatigue, QoL, anxiety, depression) at 18 and 26 weeks. The significant effect on fatigue and QoL persisted up to 12-month follow-up. Significant decreases in BMI, fat mass, and increased muscle endurance and cognitive flexibility were observed at 26 weeks, but did not persist afterward. Leisure physical activity was enhanced in the APAD group vs UC group at 18 and 26 weeks. No significant effect of the intervention was found on major macronutrients intake. CONCLUSIONS: A combined diet and exercise intervention during chemotherapy and radiotherapy in patients with early breast cancer led to positive changes in a range of psychological, physiological and behavioral outcomes at the end of intervention. A beneficial effect persisted on fatigue and QoL at long term, i.e., 1 year post-intervention. Diet-exercise supportive care should be integrated into the management of early breast cancer patients. TRIAL REGISTRATION: The APAD study was prospectively registered on ClinicalTrials.gov (NCT01495650; date of registration: December 20, 2011).

Rationale, design and conduct of a school-based anti-smoking intervention: the "PEPITES" cluster randomized trial.

BACKGROUND: In France smoking initiation rates amongst 11 to 16 year-olds are worryingly high. Several studies show that early initiation to psycho-active substances is a strong predictor of tobacco addiction. Decreasing the age at which tobacco use starts represents a key challenge for reducing tobacco usage. Implementing an intervention trial using educational workshops based on the Theory of Planned Behavior (TPB) and covering the 4 years of secondary school could be effective. METHODS: "PEPITES" is an interventional research, using a cluster randomized design. It will allow assessing the effectiveness of interventions both in reducing the tobacco initiation rate and the regular smoking rate of secondary school pupils. We will also evaluate the process of the implementation of the study and thus will help to the transferability of the intervention. A partnership convention was signed between the JDB Foundation and the National Education authority which designated 6 secondary state schools for the PEPITES trial. The 6 schools were randomly allocated to 3 groups of 2 clusters each: 1 control group, 2 different intervention groups with 2 workshops per year during 4 years; In one of this group the 2 last workshops will be dedicated to measure the loss of taste due to tobacco smoking. In each school, all pupils in year 1 with a signed parental authorization (744 pupils) have been included in the trial. The interventions targets one of the variables of the TPB and the reinforcement of psycho-social competencies. We estimated that we could detect a reduction of increase ≥5.5 and 8% respectively in the 2 principal outcomes (risk α of 5%, and ß of 80%). DISCUSSION: Carrying out a randomized prevention trial in the school environment raises specific problems which it seems useful to detail for other educational actors who would like to perform a similar study. This discussion concerns the acceptation and cooperation of the National Education partners, the risks of contamination, the information given to parents and pupils and their consent, and the representativeness of the schools involved. TRIAL REGISTRATION: ISRCTN85812512 . Registered 15 May 2018 by BioMed Central. (retrospectively registered).

The EUROMED CANCER network: state-of-art of cancer screening programmes in non-EU Mediterranean countries.

BACKGROUND: The EUROMED CANCER Network project aims to support non-EU Mediterranean countries in the development of cancer early detection and screening policies. METHODS: Through a structured questionnaire information from 15 countries (Albania, Algeria, Bosnia and Herzegovina (BiH), Croatia, Egypt, Jordan, UN Interim Administration Mission in Kosovo, Lebanon, Montenegro, Morocco, Palestinian National Authority, Serbia, Syria, Tunisia and Turkey) were collected on cancer epidemiology and control. RESULTS: Large differences between countries are evident. Breast cancer (BC) is the commonest cancer among women, though the incidence rate is much lower in non-EU than in EU Mediterranean countries. Conversely, cervical cancer (CC) is much more common in the former than in the latter countries. Colorectal cancer (CRC) is more frequent in Northern than in Eastern and Southern Mediterranean shores. Population-based cancer registries are available in few countries but most of them lack information on disease staging. Opportunistic screening for CC and BC is unevenly spread across and within countries; organised screening programmes are rare and do not meet international recommendations. BC and CC early detection is extensively considered a priority, while a few countries included CRC into their agenda. CONCLUSIONS: Collected data witnesses inadequacy of health information system and, in general, of the strategies for cancer control in the involved countries. A uniform approach for strengthening cancer control is not realistic neither feasible. Tailored preventive actions for cancer early detection have to be started concurrently with the development of a reliable health information system and, specifically, with cancer registration.

Prevalence of type-specific HPV infection in Uruguay.

The aim of this work was to describe the prevalence of type-specific Human papillomavirus (HPV) infection in women attending organized cervical cancer screening program in Uruguay. Nine hundred sixty-five liquid cervical cell samples obtained after collection of cervical smears for cytology were assessed for HPV DNA using the Papillocheck system (Greiner BioOne). The overall prevalence of High-Risk (HR) HPV infections was 20.8% and increased from 16.5% in women with normal cytology to 93.3% in HSIL. Prevalence of HPV 16 and/or 18 was 6.3% and HPV 16 was the most prevalent genotype in normal cytology (3.6%). The five most prevalent genotypes were HPV 16, 31, 51, 56, and 39. The overall prevalence peaked below age 30. This study provides essential baseline information at national level on type-specific HPV prevalence in Uruguay before the introduction of HPV vaccination. It documents the current prevalence of each of the oncogenic genotypes in a population attending cervical cancer screening program, suggesting that at least 64.7% of high risk lesions are potentially preventable by available HPV vaccines, and possibly augmentable if cross-protection against non-vaccine HPV types 31, 33, and 45 is confirmed.

Women's participation in breast cancer screening in France--an ethical approach.

BACKGROUND: Breast cancer is a major public health challenge. Organized mammography screening (OS) is considered one way to reduce breast cancer mortality. EU recommendations prone mass deployment of OS, and back in 2004, France introduced a national OS programme for women aged 50-74 years. However, in 2012, participation rate was still just 52.7%, well short of the targeted 70% objective. In an effort to re-address the (in) efficiency of the programme, the French National Cancer Institute has drafted an expert-group review of the ethical issues surrounding breast cancer mammography screening. DISCUSSION: Prompted by emerging debate over the efficiency of the screening scheme and its allied public information provision, we keynote the experts' report based on analysis of epidemiological data and participation rate from the public health authorities. The low coverage of the OS scheme may be partly explained by the fact that a significant number of women undergo mammography outside OS and thus outside OS criteria. These findings call for further thinking on (i) the ethical principles of beneficence and non-malfeasance underpinning this public health initiative, (ii) the reasons behind women's and professionals' behavior, and (iii) the need to analyze how information provision to women and the doctor-patient relationship need to evolve in response to scientific controversy over the risks and benefits of conducting mammographic screening. SUMMARY: This work calls for a reappraisal of the provision of screening programme information. We advocate a move to integrate the points sparking debate over the efficiency of the screening scheme to guarantee full transparency. The perspective is to strengthen the respect for autonomy allowing women to make an informed choice in their decision on whether or not to participate.

[Organized colorectal cancer screening]. / Le dépistage organisé des cancers colorectaux.

Organized colorectal screening in France was extended to the whole of the country in 2008. People aged from 50 to 74 years are offered fecal occult blood tests (FOBT) every two years. Patients with individual or familial risk factors for colorectal disease are excluded from the program. Despite promotion campaigns, the participation rate remains low, at about 30 %. It has been decided that a quantitative immunogical test will replace FOBT in the near future. The evaluation and use of colonoscopy and recto-sigmoidoscopy as screening tests must be re-evaluated in the light of recent research findings.

Testing for human papillomavirus and measurement of viral load of HPV 16 and 18 in self-collected vaginal swabs of women who do not undergo cervical cytological screening in Southern France.

Self-sampling using vaginal swabs could be a valuable alternative to screen for cervical cancer for women who do not attend regular cytological screening. The aim of this study was to determine the prevalence of high and low-risk HPV types and of HPV type 16 and 18 DNA load in self-collected vaginal swabs from 35- to 69-year-old Southern French women of low socioeconomic level or migrant populations who do not attend regular cervical screening. A good concordance (93.1%) was found between cervical brush and vaginal swabs in 29 samples. Self-collected vaginal swabs were examined from 120 women. HPV infection was found in 28 women (23.3%; median age 48 years), 17 (14.1%) of whom harbored high-risk HPV types. HPV type 16 was the high risk type found most frequently, followed by types 53, 31, 18, 58, and 66. The low-risk type detected most frequently was HPV type 6, followed by types 61, 70, and 81. The mean HPV 16 and 18 load was 6.3 log(10) copies/10(6) cells and 2.4 log(10) copies/10(6) cells, respectively. These results suggest that vaginal self-swabs can be a reliable tool for cervical cancer screening in non-attending and inadequately screened elderly women.

[Breast cancer epidemiology]. / Épidémiologie des cancers du sein.

The breast is the leading cancer site in women throughout the world. That said, breast cancer incidence varies widely, ranging from 27/100,0002 (Central-East Asia and Africa) to 85-94/100,0002 (Australia, North America and Western Europe). Its frequency in France is among the highest in Europe. While in most countries, its incidence has been increasing for more than 40 years, in a few other countries (USA, Canada, Australia, France…), it has been decreasing since 2000-2005. Possibly due to a substantial reduction of hormone-based treatments at menopause, the decrease may be transient. It is also the leading cause of female cancer deaths in almost all countries, with the exception of the most economically developed, in which it is currently second to lung cancer. That much said, for thirty years in highly industrialized countries such as France, breast cancer mortality has been declining. Taken together, early diagnosis and improved treatment explain this success. In France, 5-year survival and 10-year survival approximate 88 % and 78 % respectively; these rates are among the most elevated in Western Europe. Excess mortality due to breast cancer is consequently low (<5 %) but variable according to age, and maximal during the first two years of follow-up. Several thousand epidemiological studies on risk factors for breast cancer have been carried out worldwide; it is difficult to draw up an overall assessment, especially insofar as the identified factors interact and vary according to whether the cancers occur before or after menopause and depending on their histological, biological (receptors) or molecular characteristics. Moreover, their prevalence varies in time and from one region to another. For the majority of these factors, the level of relative risk is≤2. Genetic particularities: presence of proliferative mastopathy, a first child after 35 years of age and thoracic irradiation are the sole factors entailing relative risk from 2 to 5 (comparatively speaking, the risk levels associated with tobacco consumption reach values from 10 to 20, and in some cases even higher). However, exposure to risk factors≤2 may be relatively frequent and consequently favorable to development of a substantial number of breast cancers. Estimation (based on degree of risk and frequency of exposure) of the proportion of risk attributable to a given factor facilitates decision-making aimed at determining the most effective primary prevention actions. Taking into consideration the identified factors pertaining to post-menopausal cancers, only 35 % [23 to 45 %] of the attributable proportions could be reduced by primary prevention. In view of achieving this level of reduction, it is possible to put forward the following recommendations: for the women themselves: have a first child before the age of 30, breastfeed for several months, engage in sufficiently intense and regular physical activity, avoid or reduce excess weight after turning thirty, avoid exposure to active or passive smoking, limit alcohol consumption; for their physicians: do not prescribe pointless thoracic irradiations (unnecessary mammography in particular) or unjustified hormonal treatments. *persons/years.

Low participation in organized colorectal cancer screening in France: underlying ethical issues.

International studies have shown a significant reduction in colorectal cancer (CRC) mortality following the implementation of organized screening programs, given a sufficient participation rate and adequate follow-up. The French national CRC screening program has been generalized since 2008 and targets 18 million men and women aged 50-74 years. Despite broad recommendations, the participation rate remains low (29.8%), questioning the efficiency of the program. A panel of experts was appointed by the French National Cancer Institute to critically examine the place of autonomy and efficiency in CRC screening and propose recommendations. In this paper, we explore the ethical significance of a public health intervention that falls short of its objectives owing to low take-up by the population targeted. First, we analyze the reasons for the low CRC screening participation. Second, we examine the models that can be proposed for public health actions, reconciling respect for the individual and the collective good. Our expert panel explored possible ways to enhance take-up of CRC screening within the bounds of individual autonomy, adapting awareness campaigns, and new educational approaches that take into account knowledge and analysis of sociocultural hurdles. Although public health actions must be universal, target actions should nonetheless be developed for nonparticipating population subgroups.

Guideline implementation for breast healthcare in low- and middle-income countries: diagnosis resource allocation.

A key determinant of breast cancer outcome in any population is the degree to which newly detected cancers can be diagnosed correctly so that therapy can be selected properly and provided in a timely fashion. A multidisciplinary panel of experts reviewed diagnosis guideline tables and discussed core implementation issues and process indicators based on the resource stratification guidelines. Issues were then summarized in the context of 1) clinical assessment, 2) diagnostic breast imaging, 3) tissue sampling, 4) surgical pathology, 5) laboratory tests and metastatic imaging, and 6) the healthcare system. Patient history provides important information for the clinical assessment of breast and comorbid disease that may influence therapy choices. Focused clinical breast examination and complete physical examination provide guidance on the extent of disease, the presence of metastatic disease, and the ability to tolerate aggressive therapeutic regimens. Breast imaging improves preoperative diagnostic assessment and also permits image-guided needle sampling. Diagnostic mammography was not considered mandatory in low- and middle-income countries when resources are lacking. Needle biopsy is preferred to surgical excision for the initial diagnosis of suspicious breast lesions, unless resources are unavailable. Mastectomy should never be used as a method of tissue diagnosis. The availability of predictive tumor markers, especially estrogen receptor testing, is critical when endocrine therapies are available; quality assessment of immunohistochemistry testing is important to avoid false-negative results. Incremental allocation of resources can help address economic disparities and help ensure equity in access to timely diagnosis.

Occupation and skin cancer: the results of the HELIOS-I multicenter case-control study.

BACKGROUND: Non-melanoma skin cancer (NMSC) is the most frequent tumour among Caucasian populations worldwide. Among the risk factors associated with this tumour, there are host-related factors and several environmental agents. A greater likelihood of high exposure to physical agents (with the exception of solar radiation) and chemical agents depends on the work setting. Our objective is to evaluate the role of occupational exposures in NMSC, with special emphasis on risk factors other than solar radiation and skin type. METHODS: We analysed 1585 cases (1333 basal cell carcinoma (BCC) and 183 squamous cell carcinoma (SCC)) and 1507 controls drawn from the Helios-I multicenter study. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using logistic regression mixed models. RESULTS: For NMSC as a whole (both histological types), miners and quarrymen, secondary education teachers, and masons registered excess risk, regardless of exposure to solar radiation and skin type (OR 7.04, 95% CI 2.44-20.31; OR 1.75, 95% CI 1.05-2.89 and OR 1.54, 95% CI 1.04-2.27, respectively). Frequency of BCC proved higher among railway engine drivers and firemen (OR 4.55; 95% CI 0.96-21.57), specialised farmers (OR 1.65; 95% CI 1.05-2.59) and salesmen (OR 3.02; 95% CI 1.05-2.86), in addition to miners and quarrymen and secondary education teachers (OR 7.96; 95% CI 2.72-23.23 and OR 1.76; 95% CI 1.05-2.94 respectively). The occupations that registered a higher risk of SCC (though not of BCC) were those involving direct contact with livestock, construction workers not elsewhere classified (OR 2.95, 95% CI 1.12-7.74), stationary engine and related equipment operators not elsewhere classified (OR 5.31, 95% CI 1.13-21.04) and masons (OR 2.55, 95% CI 1.36-4.78). CONCLUSION: Exposure to hazardous air pollutants, arsenic, ionizing radiations and burns may explain a good part of the associations observed in this study. The Helios study affords an excellent opportunity for further in-depth study of physical and chemical agents and NMSC based on matrices of occupational exposure.

The future of cervical cancer prevention in Europe.

Cervical cancer remains a significant source of disease and death in Europe. However, we now have the means to prevent virtually every case of cervical cancer through comprehensive, population-based, organised cervical cancer prevention programmes that effectively integrate cervical screening with the new technologies and vaccines that are now available. Given the potential health benefits of these programmes in reducing disease incidence and mortality, their establishment is now an ethical imperative for all European countries.

[From information to prevention]. / Au-delà de l'information, la prévention.

Primary prevention of the most frequent and most lethal health disorders (cancer, cardiovascular disease, accidents) focuses mainly on changing at-risk behaviors, but this cannot be achieved simply by distributing information. Factors that subtend changes in individual behavior must also be taken into account, along with people's cultural, social, physical and economic environment. Thus, health prevention campaigns will be more effective if they reinforce the capacity to control determinants of individual and public health. Such campaigns must therefore include multiple strategies aimed at changing both the social context and people's lifestyle values.

[Vaccination against human papillomavirus. Implementation and efficacy against cervical cancer control]. / Les vaccins des papillomavirus humains. Leur place dans la prévention du cancer du col utérin.

The two new HPV vaccines (Gardasil quadrivalent and Cervarix bivalent 16,11) are both effective against HPV types 16 and 18, which are responsible for 70% of cervical cancers, and the quadrivalent vaccine is effective against HPV 6 and 11, responsible for genital warts. Their efficacy is 100% if they are administered before exposure to HPV 16,18. The proven duration of protection against high-grade cervical lesions is currently 5 years, and the need for boosters is unknown. Cervical cancer screening programs must continue, as only 70% of the 15 high-risk HPV types are targeted. The best age for primary vaccination appears to be 11-12 or 14 years, before the outset of sexual activity. Vaccination of older women is less efficacious, and vaccination of males is being discussed. HPV vaccines should be useful in developing countries, if they can be made available. HPV vaccination campaigns require adequate public information.

Effect of cigarette smoke on gustatory sensitivity, evaluation of the deficit and of the recovery time-course after smoking cessation.

BACKGROUND: Study results have shown that chronic exposure to cigarette smoke affects the taste function in humans. However, neither the quantitative impact on taste sensitivity nor the time-course of taste recovery on stopping smoking have been precisely examined. METHODS: The experimental design included 2 phases, (i) a case-control phase comparing the taste sensitivity level measured by Electrogustometric (EGM) thresholds from various parts of the tongue (locus) between smokers (n = 83) and non-smokers (n = 48), (ii) a follow-up study looking at the taste sensitivity recovery in smokers after smoking cessation (n = 24) and compared with non-smokers. RESULTS: Smokers exhibited significantly lower taste sensitivity than non-smokers - the higher the nicotine dependence (Fagerström scores), the lower the taste sensitivity. After smoking cessation, EGM thresholds decreased progressively, and reached the taste sensitivity range of non-smokers depending on locus and time. After 2 weeks a recovery could be observed on the 3 Tip and the 2 edge loci; the recovery in the posterior loci was complete after 9 weeks, and in the dorsal loci recovery was observed only after 2 months or more. CONCLUSIONS: Smoking cessation does lead to a rapid recovery of taste sensitivity among smokers, with recovery time found to differ based on the sensitivity of loci of the tongue. The use of EGM could potentially be explored as a motivational tool for smoking cessation.

Implementing an organised cervical screening programme in the Republic of Moldova-Stakeholder identification and engagement.

INTRODUCTION: Successfully implementing cervical screening programmes requires them to be adapted to the local context and have broad stakeholder support. This can be achieved by actively engaging local stakeholders in planning as well as implementing the programmes. The Moldovan government started implementing an organised cervical screening programme in 2010 with the first step being stakeholder identification and engagement. MATERIALS AND METHODS: This process started by contacting easily identified stakeholders with each asked to recommend others and the process continued until no new ones were identified. Stakeholders were then involved in a series of individual and group meetings over a 2-year period to build confidence and encourage progressively greater engagement. RESULTS: In total, 87 individuals from 46 organisations were identified. Over the 2-year process, the individual and group meetings facilitated a change in stakeholder attitudes from disinterest, to acceptance and finally to active cooperation in designing the screening programme and preparing an implementation plan that were both well adapted to the Moldovan context. DISCUSSION: Developing the broad support needed to implement cervical screening programmes required ongoing interaction with stakeholders over an extended period. This interaction allowed stakeholder concerns to be identified and addressed, progress to be demonstrated, and stakeholders to be educated about organised screening programmes so they had the knowledge to progressively take greater responsibility and ownership.

Print information to inform decisions about mammography screening participation in 16 countries with population-based programs.

OBJECTIVE: To profile and compare the content and presentation of written communications related to informed decision-making about mammography. METHODS: Materials from 16 screening programs organized at the national or regional level were analyzed according to five major information domains suggested by the international literature. RESULTS: A majority of countries provided information on the program (interval, cost and quality). There was considerable variability in comprehensiveness of elements in the domains, e.g., test characteristics (false positive/negative) and pros and cons of screening. The majority noted the likelihood of recall for further tests, few commented on the risks of additional tests or finding unimportant tumors. The audit also found variation in presentation (words and pictures). CONCLUSIONS: Presentation of comprehensive, but balanced information on screening benefits and risks is complex and daunting. Issues such as framing effects, coupled with debate about screening efficacy are challenging to the design of effective information tools. The objective of increasing screening prevalence at the population level must be balanced with objectively presenting complete and clear information. Additional research is needed on how information (and mode of presentation) impact screening decisions. PRACTICE IMPLICATIONS: Public health officials need to articulate their objectives and review written communication according to important decision-making domains.

Low-dose computed tomography screening for lung cancer in populations highly exposed to tobacco: A systematic methodological appraisal of published randomised controlled trials.

Low-dose computed tomography (LDCT) screening recommendations for lung cancer are contradictory. The French National Authority for Health commissioned experts to carry a systematic review on the effectiveness, acceptability and safety of lung cancer screening with LDCT in subjects highly exposed to tobacco. We used MEDLINE and Embase databases (2003-2014) and identified 83 publications representing ten randomised control trials. Control arms and methodology varied considerably, precluding a full comparison and questioning reproducibility of the findings. From five trials reporting mortality results, only the National Lung Screening Trial found a significant decrease of disease-specific and all-cause mortality with LDCT screening compared to chest X-ray screening. None of the studies provided all information needed to document the risk-benefit balance. The lack of statistical power and the methodological heterogeneity of European trials question on the possibility of obtaining valid results separately or by pooling. We conclude, in regard to the lack of strong scientific evidence, that LDCT screening should not be recommended in subjects highly exposed to tobacco.

Genotyping and follow-up of HR-HPV types detected by self-sampling in women from low socioeconomic groups not participating in regular cervical cancer screening in France.

BACKGROUND: HPV vaginal self-sampling can be an alternative for women refusing cytological screening. OBJECTIVES: To describe HR-HPV types in 35-69 years old women from low socioeconomic groups not attending regular cytological screening in Marseille, France. STUDY DESIGN: A cervical screening campaign using HR-HPV self-sampling including 22,702 women aged 35-69 years living in low socioeconomic districts of Marseille was organized. A cytological and/or histological follow-up was undertaken for a subset of women harboring HR-HPV types. Abbott RealTime High Risk HPV test was used for screening, while INNO-LiPA HPV Genotyping Extra assay was used for genotyping. RESULTS: 4245 self-samplings were performed (participation rate, 18.7%) out of which 609 (14.3%) were HR-HPV+ by the screening test including 114HPV 16 (18.7%), 41HPV 18 (6.7%), 454HR-HPVnon-16/18 (75.4%). A sample of 260 out of the 454HR-HPVnon-16/18 were genotyped by INNO-LiPA which revealed HPV52 (35%), 66 (22.6%), 51 (19.6%), 31 (15.7%), 39 (13%), 56 (10.4%), and 53, 35, 59, 33, 58, 82, 45, 68, 73 (<10% each). At month 12, a 2nd self-collection kit was sent to 274 of 609HR-HPV+ women who did not have a Pap-test previously performed on them. Of these 274 women, 130 provided a sample for HPV testing; one was uninterpretable, 56 were HPV negative, and 73 were HR-HPV+ (10HPV16+, 3HPV18+, 60HR-HPVnon-16/18+). Of the 345 women with cytological and/or histological follow-up 19 (5.5%) had ≥CIN2 lesions, (11 were HPV16+ and 8 were HR-HPVnon-16/18). CONCLUSION: This study illustrates the potential efficacy of self-sampling as a cancer screening strategy for socioeconomically deprived women who do not participate in regular Pap screening programs.

A randomized trial assessing the Five-Day Plan for smoking cessation.

AIM: To evaluate the effectiveness of the Five-Day Plan (FDP) in helping smokers to stop smoking. DESIGN: Randomized controlled trial comparing intervention and control groups. The primary outcome measure was 12 months continuous abstinence verified by expired air carbon monoxide concentration. Secondary outcome measures were self-reported abstinence at end of treatment, at 3 and 6 months. SETTING: Six towns in France. PARTICIPANTS: 228 smokers, recruited by newspaper and radio advertisement, aged 18 years or over and willing to make an attempt to quit smoking. INTERVENTION: The Intervention group (119 participants) received the FDP, which is a behavioural group-based treatment programme that has been in operation in France since 1965. It involves five consecutive evening behavioural therapy sessions. The Control group (109 participants) received a single session discussing the health effects of smoking. FINDINGS: In the Intervention group, 67 participants (56%) quit smoking at the end of the FDP. After three months this number had been reduced to 30 (25%) and to 19 (16%) by the end of one year. In the Control group these numbers were 14 (13%) and 12 (11%), respectively, after three and 12 months. When considering the rate of cessation without lapse after one year a significant difference was observed with a 13% rate in the Intervention group and 3% in the Control group (P = 0.004). CONCLUSIONS: The FDP may be considered as an aid for smokers who want to quit.